Effect of autonomic dysfunction on the exocrine function of the pancreas in chronic pancreatitis
Authors: Z.I. Sabat, L.S. Babinets
Journal: GASTROENTEROLOGY (2023)

Background. The article evaluates the impact of autonomic dysfunction according to the heart rate variability data and the Spielberger-Khanin questionnaire on the exocrine function of the pancreas in chronic pancreatitis (CP). The aim is to evaluate the exocrine function of the pancreas depending on the heart rate variability and survey using the Spielberger-Khanin questionnaire. Materials and methods. One hundred outpatients with a diagnosis of CP who were treated in Ternopil healthcare institutions were examined. The presence of exocrine pancreatic insufficiency was determined by the level of fecal α-elastase. The psycho-emotional state was assessed using the Spielberger-Khanin questionnaire. Statistical and spectral indicators of heart rate variability were analyzed: the range of variation, the amplitude of the mode, stress index, indicator of activity of regulatory systems, total spectrum power, absolute and percentage values of very low frequency (VLF), low frequency (LF), high frequency power (HF), the LF/HF ratio. A correlation analysis was performed of the obtained heart rate variability data, the Spielberger-Khanin questionnaire data with the degree of exocrine pancreatic insufficiency in terms of the level of fecal α-elastase. Results. The average value of reactive anxiety on the Spielberger-Khanin questionnaire is 44.33±0.89, personal anxiety is 43.19±0.82, which corresponds to the upper limit of the moderate level. A negative correlation was found between these parameters and the level of fecal α-elastase (r=–0.482, p&lt;0.01, and r=–0.555, p&lt;0.01, respectively). Based on the heart rate variability of patients with CP, a tendency among them to sympathicotonia was detected, which was accompanied by a significant increase in the amplitude of the mode, stress index, the LF/HF ratio and a decrease in the range of variation compared to the control group. In contrast to the healthy individuals, the humoral-metabolic effect of heart rhythm regulation prevailed in those with CP (VLF— (48.66±1.21)%) and the share of the nervous component (LF— (31.69±0.67)%, HF— (19.65±0.75)%) decreased, there was a significant decrease in the total power of the spectrum compared to the control group (1546.25±44.18 versus 3155.65±211.38). The indicator of the activity of regulatory systems in patients with CP (6.91±0.12) was at the upper limit of the intense load of regulatory systems, which reflects a significant impairment of adaptation among them and reliably differs from the control level (3.90±0.31). A significant correlation was found between the total power of the spectrum, indicator of the activity of regulatory systems and the level of fecal α-elastase (r=0.511, p&lt;0.01, and r=–0.398, p&lt;0.01, respectively). Conclusions. During the study, it was found that with a deterioration in the psycho-emotional state (according to the data of the Spielberger-Khanin questionnaire), exocrine insufficiency of the pancreas in patients with CP increased: there was a correlation between the content of fecal α-elastase and the level of reactive and personal anxiety. Positive statistically significant correlations between the amplitude of the mode, stress index with the duration of the course of CP indicate compensatory activation of the sympathetic division of the autonomic nervous system. It was also proved that exocrine insufficiency (according to the content of fecal α-elastase) worsened with an increase in sympathicotonia (according to the stress index). Adecrease in the functional reserve in patients with СР was revealed: a significant decrease in the total power of the spectrum was found compared to that of the control group; against this background, there was a decrease in the adaptive potential, deterioration in the psycho-emotional state, which resulted in an increase in exocrine pancreatic insufficiency. The obtained data motivate to improve the generally accepted comprehensive therapy of patients with chronic pancreatitis with the additional inclusion in it of agents to stabilize the autonomic nervous system.